Study encourages parents to begin talking to their children as early as possible to create awareness of how to navigate online identity construction.

From sexting to "Facebook depression," the online world brings up a host of issues for children and teens, according to a report released on March 28 by the American Academy of Pediatrics (AAP).

The report recommends that pediatricians talk to their patients, and their patients' parents, about cybersafety, including privacy, anonymity and cyberbullying.

"We don't want to demonize the online world or say that social media is bad," said report author Gwenn Schurgin O'Keeffe of the AAP's council on communications and media. "What we'd like is for people to slow down a bit and get to know what is happening in kids' lives."

A big chunk of kids' social development now takes place in the online world, according to the report. A study released in February 2010 found that 70 percent of wired American teens and young adults use social networking sites. A 2009 poll conducted by Common Sense Media found that more than half of teens use a social networking site more than once a day.

The issues that come up — bullying, sexual experimentation, interactions with strangers — aren't new, O'Keeffe said. But the Internet adds a twist: Bullying becomes cyberbullying, teens experiment sexually by sexting (sending explicit text messages or photos), and interactions with others are colored by anonymity. In some cases, sexts-gone-viral have led to child pornography charges being filed against kids who forward on the explicit photos. The New York Times reported on March 27 on one such a case in Washington state. The three teens charged in that case later made a deal to amend the charges to a misdemeanor, telephone harassment.

"Technology acts as a great amplifier," O'Keeffe said. Doctors, she said, know how to advise patients on these issues; they just need to learn to think of them in the context of the Internet.

Risks and rewards

The report lists several benefits of social media, including a sense of community and communication among kids. Teens have easy access to reliable health information and sexual education online. And social media often acts as a learning tool or a way to collaborate during school projects.

But navigating the online world has its share of pitfalls, O'Keeffe said. Kids and teens can inadvertently make embarrassing information or photos public — bad news for future college or job applications. "Sexts" can go viral. And cyberbullying can mean a kid never gets respite from the cruelty of peers.

Many online risks are an extension of the child's real-world interactions, O'Keeffe said. Parents and pediatricians have begun to report "Facebook depression," in which a teen becomes anxious and moody after spending a lot of time on the popular social networking site. These kids are usually those who have trouble with social interactions in general, O'Keeffe said. When they find that people aren't responding to their posts or accepting their friend requests in the online world either, it can be very distressing.

"Kids can be insecure in general, so when you take a kid that is having trouble with peers and having trouble to begin with, Facebook can heighten those anxieties to a huge degree," O'Keeffe said.

How young is too young?

The solution isn't to ban cellphones and throw the computer out the window, O'Keeffe said. Instead, parents and doctors need to think about the online world like they do the real world, and give kids instruction to navigate it successfully.

Kids can start exploring the Internet with their parents during preschool, O'Keeffe said, but they shouldn't be left unattended. As they age, they might gravitate toward child-friendly social media sites like Club Penguin, a multiplayer game site designed for kids ages 6 to 14. Facebook doesn't allow users under the age of 13, and parents should respect that, O'Keeffe said.

"To get your kid on Facebook younger than that you have to lie about the child's age. … It's a bad idea," she said.

The content on Facebook is intended for an older audience, O'Keeffe said, and telling children it's okay to lie about age online sets a bad precedent.

Both pediatricians and parents should broach conversations about kids' online life early, O'Keeffe said. Doing so makes it more likely that children will come to parents if their Internet interactions start to sour. O'Keeffe recommended healthychildren.org and the media-review site commonsensemedia.org as well as her book, "Cybersafe: Protecting and Empowering Kids in the Digital World of Texting, Gaming, and Social Media" (American Academy of Pediatrics, 2010) for tips on how to approach the topic.

"In the end what everyone has to focus on is helping our kids be good citizens," O'Keeffe said. "And what that means in today's world is including technology in the mix."